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Lewis H. Margolis, MD, MPH; Alexander C. Wagenaar, PhD; Lisa J. Molnar, MHSA

Am J Dis Child. 1992;146(3):361-366.

Abstract
• Objective.
—To determine demographic, social, and behavioral characteristics that are associated with correct child restraint device (CRD) use.

Design.
—Cross-sectional.

Setting.
—Fast-food restaurant parking lots in southeastern Michigan.

Participants.
—Children younger than age 4 years and their drivers.

Selection Procedures.
—Consecutive sample.

Intervention.
—None.

Measurements/Main Results.
—Seven hundred seventeen child passengers were observed for 11 dimensions of CRD use and 661 of their drivers were interviewed. Three hundred ninety-four (55%) of the children were in CRDs, but 248 (63%) of those children were incorrectly restrained. A 43-point misuse index was constructed based on scores assigned for different types of misuse. Seven variables (ie, age of child, race of parent, driver as a parent, days driving, number of occupants, perceived comfort of CRDs, and belief that the social norm supports CRD use) were highly predictive of CRD use. In contrast, only three factors (ie, age of child, education of the driver, and knowledge of the CRD law) were minimally predictive of correct use.

Conclusions.
—Since correct use of CRDs represents such a complex behavior, the best strategy to address the widespread problem of CRD use may be through the design of less complicated CRDs.

(AJDC. 1992;146:361-366)

Author Affiliations
From the Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill (Dr Margolis); the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Wagenaar); and the Transportation Research Institute of the University of Michigan, Ann Arbor (Ms Molnar).

Footnotes
Accepted for publication November 19, 1991.

Presented in part at the annual meeting of the American Public Health Association, Chicago, Ill, October 23, 1989.

Reprint requests to the Department of Maternal and Child Health, University of North Carolina, Rosenau Hall, Chapel Hill, NC 27599 (Dr Margolis).

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